Abdullah Gunes, Nuray Colapkulu-Akgul, Caner Akgul, Ibrahim Unlu, Saffet Cinar
{"title":"Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes.","authors":"Abdullah Gunes, Nuray Colapkulu-Akgul, Caner Akgul, Ibrahim Unlu, Saffet Cinar","doi":"10.5144/0256-4947.2025.145","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer.</p><p><strong>Objective: </strong>Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on immunohistochemical subtypes and its correlation with sentinel lymph node biopsy (SLNB) results.</p><p><strong>Design: </strong>A retrospective cohort.</p><p><strong>Setting: </strong>Tertiary oncology center in Turkiye.</p><p><strong>Patients and methods: </strong>Patients diagnosed with early-stage invasive ductal breast cancer and who underwent preoperative F-18 fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) evaluation were included in the study. Patients were divided into five immunohistochemical subtypes: Luminal A, Luminal B HER2 (-) (human epidermal growth factor receptor 2), Luminal B HER2 (+), HER2 (+), and triple negative. SLNB and SUVmax (Maximum Standard Unit Value) results were compared.</p><p><strong>Main outcome measures: </strong>Diagnostic accuracy of 18F-FDG PET/CT for detecting axillary metastasis was the primary outcome. Interrater reliability testing in determining the agreement between 18F-FDG PET/CT and SLNB was the secondary outcome.</p><p><strong>Sample size: </strong>248.</p><p><strong>Results: </strong>The sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG-PET/CT for detecting axillary metastasis were 62%, 92%, 88%, 71% and 77%, respectively. Cohen's Kappa coefficient (0.54) showed moderate agreement with SLNB (<i>P</i><.001). Tumors with positive HER2 gene amplification [HER2 (+) and Luminal B HER2 (+) have higher sensitivity than other subtypes (Luminal A, Luminal B HER2 (-) and triple negative). HER2 gene amplification also increases the agreement between 18F-FDG-PET/CT and SLNB results.</p><p><strong>Conclusion: </strong>18F-FDG-PET/CT has a high specificity but low sensitivity for ipsilateral axillary metastasis in invasive ductal carcinoma. The presence of HER2 gene amplification can increase sensitivity and concordance with SLNB.</p><p><strong>Limitations: </strong>Retrospective design and limited number of patients for each subtype.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 3","pages":"145-153"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145192/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5144/0256-4947.2025.145","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/5 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer.
Objective: Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on immunohistochemical subtypes and its correlation with sentinel lymph node biopsy (SLNB) results.
Design: A retrospective cohort.
Setting: Tertiary oncology center in Turkiye.
Patients and methods: Patients diagnosed with early-stage invasive ductal breast cancer and who underwent preoperative F-18 fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) evaluation were included in the study. Patients were divided into five immunohistochemical subtypes: Luminal A, Luminal B HER2 (-) (human epidermal growth factor receptor 2), Luminal B HER2 (+), HER2 (+), and triple negative. SLNB and SUVmax (Maximum Standard Unit Value) results were compared.
Main outcome measures: Diagnostic accuracy of 18F-FDG PET/CT for detecting axillary metastasis was the primary outcome. Interrater reliability testing in determining the agreement between 18F-FDG PET/CT and SLNB was the secondary outcome.
Sample size: 248.
Results: The sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG-PET/CT for detecting axillary metastasis were 62%, 92%, 88%, 71% and 77%, respectively. Cohen's Kappa coefficient (0.54) showed moderate agreement with SLNB (P<.001). Tumors with positive HER2 gene amplification [HER2 (+) and Luminal B HER2 (+) have higher sensitivity than other subtypes (Luminal A, Luminal B HER2 (-) and triple negative). HER2 gene amplification also increases the agreement between 18F-FDG-PET/CT and SLNB results.
Conclusion: 18F-FDG-PET/CT has a high specificity but low sensitivity for ipsilateral axillary metastasis in invasive ductal carcinoma. The presence of HER2 gene amplification can increase sensitivity and concordance with SLNB.
Limitations: Retrospective design and limited number of patients for each subtype.
背景：乳腺癌是全球女性最常见的癌症之一。腋窝淋巴结转移仍然是乳腺癌最独立的预后因素之一。目的：评价18F-FDG-PET/CT基于免疫组化亚型检测腋窝淋巴结转移的诊断准确性及其与前哨淋巴结活检（SLNB）结果的相关性。设计：回顾性队列研究。地点：土耳其三级肿瘤中心。患者和方法：诊断为早期浸润性导管性乳腺癌且术前接受F-18氟脱氧葡萄糖正电子发射计算机断层扫描（18F-FDG PET/CT）评估的患者纳入研究。将患者分为5个免疫组化亚型：Luminal A、Luminal B HER2(-)（人表皮生长因子受体2）、Luminal B HER2（+）、HER2（+）和三阴性。SLNB和SUVmax（最大标准单位值）结果比较。主要观察指标：18F-FDG PET/CT检测腋窝转移的诊断准确性是主要观察指标。用于确定18F-FDG PET/CT和SLNB之间一致性的判读器信度测试是次要结果。样本量：248。结果：18F-FDG-PET/CT检测腋窝转移的敏感性为62%，特异性为92%，PPV为88%，NPV为71%，准确性为77%。结论：18F-FDG-PET/CT对浸润性导管癌同侧腋窝转移具有高特异性但低敏感性。HER2基因扩增的存在可增加与SLNB的敏感性和一致性。局限性：回顾性设计，每个亚型的患者数量有限。
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